Provider Demographics
NPI:1477844876
Name:THEIS, WENDY JEA (LIMHP, LCSW, LMSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEA
Last Name:THEIS
Suffix:
Gender:F
Credentials:LIMHP, LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 PACIFIC ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-5428
Mailing Address - Country:US
Mailing Address - Phone:701-240-7033
Mailing Address - Fax:701-240-7033
Practice Address - Street 1:7602 PACIFIC ST
Practice Address - Street 2:SUITE 304
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-5428
Practice Address - Country:US
Practice Address - Phone:701-240-7033
Practice Address - Fax:701-240-7033
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14441041C0700X
IA0076691041C0700X
NE1383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical